Oncology Flashcards
How common is cancer in children?
Rare < 1% of all cases of malignancy Average GP will see 1 case in 15 years Average DGH will see 5 cases a year 1 in 8000 develops cancer every year 1 in 600 develops cancer before age of 15
How common is death in chilhood?
In 1st year of life - 580 deaths per 100,000
Age 1-4 27 deaths per 100,000
Age 5-14 12 deaths per 100,000
What are the main causes of death in children?
Injury Cancer CNS disorders Respiratory disease Congenital abnormalities Infectious causes
How has survival of cancers improved?
Improved over the last 30 years
- > 75% cured
- 1 in 900 adults had cancer as a child
What has the change in cancer survival done in terms of effects of treatment?
New problems - longer survival, new therapies
Life long follow-up essential
What are the differences between adult and childhood cancers?
Carcinomas are very rare in children
Embryonal tumours are rare in adults
Leukaemia occurs at all ages but more common in younger children
Bone tumours and lymphomas - peak incidence in early adolescence and early adulthood
Name 2 types of embryonal tumours
Wilms - kidney
Neuroblastoma
Rhabdomyosarcoma
What causes cancer in children?
Most cases unknown cause
- < 5% due to identifiable genetic abnormalities
- Double hit theory - interaction between environment and genetic susceptibility
Mutations in cellular genes
- Oncogenes, tumour suppressor genes, inherited eg retinoblastoma or sporadic
Some children at increased risk of cancer - Downs, immuno-compromised, NF1
How can cancers in children present?
Localised mass - lymphadenopathy, organomegaly, soft tissue or bony mass
Problems from disseminated disease - bone marrow infiltration
Problems from localised mass - airway obstruction from lymphadenopathy
Non-specific symptoms
What could the diagnosis be in a child with recent UTI, pale and tired?
Post viral
Leukaemia
What could the diagnosis be in a child with lump in neck, otherwise well?
Atypical mycobacteria
Hodgkin’s
What could the diagnosis be in a child with early morning headache?
Sinusitis
Brain tumour
What could the diagnosis be in a child with recurrent fever and bone pain?
Arthritis
Leukaemia
Ewing’s
Neuroblastoma
What could the diagnosis be in a child with abnormal red reflex in eye?
Retinoblastoma
What could the diagnosis be in a child with proptosis?
Infection
Neuroblastoma
Rhabdomyosarcoma
What could the diagnosis be in a child with recurrent discharging ear?
Infection
Rhabdomyosarcoma
LCH
When should you consider malignancy in children?
In any child whose condition doesn’t resolve or respond to treatment in the normal way
What is the most common type of ALL?
B cell
How does ALL present?
Fever Fatigue Frequent infection Lymphadenopathy Hepatomegaly and/or splenomegaly Anaemia Bruising/petechiae Bone or joint pain
What investigations should you do for ALL?
Blood film Serum chemistry CXR Bone marrow aspirate LP
What is the treatment for ALL?
Chemotherapy - 5 phases
Haemopoietic stem cell transplant
What are the 5 stages of chemotherapy and how does it differ from boys to girls and why?
Induction Consolidation Interim management Delayed intensification Maintenance Boys treated for longer as higher risk of relapse
When do you give haemopoietic stem cell transplants?
High risk patients in first remission
Relapsed patients
How do CNS tumours present?
Signs of raised ICP - headache often worse lying down, vomiting especially early morning, papilloedema Squint Nystagmus Ataxia Personality or behaviour change
When should you scan a child with a headache?
If also papilloedema, decreased acuity or visual loss
If other neurological signs
If recurrent and/or early morning
If associated with vomiting - persistent, more frequent, preceded by headache
If also have short stature/decelerated linear growth
If age < 3
If have neurofibromatosis
What are the different types of CNS tumours and what are their prognoses?
Pilocytic astrocytoma - low grade, best survival rate, high grade less so
Medulloblastoma 70%
Pontine glioma - palliative care
Neuroblastoma
How are CNS tumours treated?
Surgery - resection, VP shunt
Chemotherapy - single agent/combination
Radiotherapy - for malignant tumours in older children, whole brain not used in very young
How common is lymphadenopathy in children?
Up to 50%
Very common
Mostly due to self-limiting benign cause
What can cause lymphadenopathy?
HIV
Autoimmune conditions
Storage disorders
Malignancy
When should you biopsy lymphadenopathy?
Enlarging node without clear infective cause
Persistently enlarged node
Unusual site eg supraclavicular
Associated S&S
Fever, weight loss, enlarged spleen/liver
Abnormal CXR
How is paediatric lymphoma treated?
Chemotherapy - determined by histology and stage
Radiotherapy - Hodgkin’s to residual bulk disease, NHL rarely
Surgery - mainly limited to biopsy
High dose therapy mainly for relapse
Survival relatively good for both types
How might an abdominal tumour present?
Mass only/with additional symptoms Pain Haematuria Constipation Hypertension Weight loss
What investigations should you do for an abdominal mass?
USS
CT scan
Biopsy
What is the most common type of abdominal tumour in children?
Wilm’s
How is a neuroblastoma treated?
Surgery - primary if resectable or following chemotherapy
Chemotherapy - type determined by stage and biology, high dose with HPSC high risk groups
Radiotherapy - mainly for high risk groups or at relapse
What is a neuroblastoma?
Develops from neuroblasts left behind from babies development in womb so mainly affects babies and young children
Commonly occurs in one of the adrenal glands above kidneys or in nerve tissue next to spinal cord
Can spread to bone marrow, bone, lymph nodes, liver, and skin
How common is neuroblastoma?
Affects around 100 children each year in UK
Most common in children under 5
What are the possible symptoms for neuroblastoma?
Swollen, painful abdomen, constipation, difficulty urinating
SOB, dysphagia
Lump in neck
Blue tinged skin and bruising around eyes
Weakness in legs, unsteady walk, numbness in lower body
Fatigue, loss of energy, pale skin
Loss of appetite, weight loss
Bone pain, limp
General irritablity
How is Wilm’s tumour treated?
Chemotherapy prior and following surgery
Nephrectomy/partial nephrectomy if bilateral
Radiotherapy if residual abdominal or pulmonary disease
What is a retinoblastoma?
Eye cancer
Who does retinoblastoma usually affect?
Children < 5
What is the prognosis of retinoblastoma?
90% cured
Can affect one or both eyes
If both eyes - diagnosed before age of 1 usually
If one eye - diagnosed between 2 and 3
What are the symptoms of retinoblastoma?
Unusual white reflection in pupil Squint Change in colour of iris - in one eye or one area of eye Red or inflamed eye Poor vision Loss of red reflex
What can cause retinoblastoma?
Inherited - RB1 gene
Familial 40%
Sporadic
How is retinoblastoma treated?
Multimodal therapy
What are the late effects of treatment for cancer in children?
Endocrine - growth and development issues Intellectual Cardiac toxicity Renal toxicity Fertility Psychological
